Clinical integration is an increasingly popular strategy for
hospitals to align with physicians and improve the cost and quality of care.
Dennis Butts, a manager in Dixon Hughes Goodman's healthcare strategy practice,
shares seven strategies for hospitals to successfully develop a clinical
integration network.
1. Cultivate physician leaders. A successful clinical
integration strategy requires the integrated network to be physician led and
physician driven, according to Mr. Butts. "Physicians have to have enough
power and authority to effect change — to [determine] how quality is defined,
what protocols will be developed and how to hold each other accountable for
meeting objectives."
To lead the network effectively, it is critical for
physicians to be involved in creating the clinically integrated model from the
beginning; they need to have a voice in designing the structure of the network.
"You can't expect a physician-driven initiative after you've already
planned [the network] in the hospital and expect them to buy in to what you've
already developed," Mr. Butts says.
Giving physicians leadership roles may require a cultural
change in the hospital, as historically hospital administration and physicians
have worked separately. "It's a real paradigm shift for most organizations
where they're allowing physicians to have a significant say in how things are
done at the hospital," Mr. Butts says. Physicians may also have to change
their workflows to be successful in their new roles. "Physicians are going
to be asked to do things differently and be held accountable for things they
maybe haven't been in the past," he says.
2. Provide hospital management. Creating a physician-led
clinical integration network does not mean clinical integration is solely run
by physicians, however. The most successful programs have embraced a
physician-led, professionally-managed culture that maximizes the experience and
expertise of physicians and hospital administration, according to Mr. Butts.
The hospital can provide data analytics and other resources and expertise to
ensure the network is supported from a management perspective.
3. Communicate often. Another critical aspect of clinical
integration is frequent communication between all parties. Clinical integration
is a major change initiative and leaders should seek medical staff input early
and often, according to Mr. Butts. He says one common mistake in developing
clinical integration networks is when leaders assign small committees to work
on different initiatives, but don't have a robust strategy for these committees
to communicate with each other and to the broader medical staff.
4. Choose metrics. Clinical integration networks should
choose metrics that span the continuum of care, according to Mr. Butts.
"Make sure your metrics cover the inpatient side as well as the outpatient
side, so you're not focused on just what happens in the hospital, but also
what's happening in the physician practice," he says. He also suggests
focusing on metrics related to care transitions between sites and adopting the
same metrics across payors.
5. Invest in infrastructure. A successful clinical
integration network requires investment in infrastructure that can connect the
hospital and physicians through patient registries and other electronic
systems. A robust infrastructure provides the tools physicians and hospitals
need to monitor quality and cost. "Without that infrastructure in place or
access to real-time data, physicians will not be able to change [clinical]
patterns to achieve the objectives of the network," Mr. Butts says.
Clinical integration networks can reduce the cost of
developing appropriate infrastructure by building off an existing structure.
For example, Mr. Butts says the network can build upon the infrastructure
already in place from a messenger model physician-hospital organization or
independent practice association if they exist. "Instead of recreating the
wheel, see if there's an entity already created that is still usable to reach
the objectives you're trying to meet," Mr. Butts says.
6. Create a short-term win. When hospitals and physicians
develop a clinical integration network, they can build payors' support of the
network by quickly demonstrating improvement. Targeting low-hanging fruit to
demonstrate improved quality and cost can help validate the clinical integration
model. Oftentimes hospitals go after low-hanging fruit by starting with
hospital efficiency initiatives in the acute setting or within the
hospital-sponsored health plan. When the network negotiates with payors, it can
use data from these initial improvements to attain favorable contracts,
according to Mr. Butts.
7. Determine a distribution method. Leaders must develop a
methodology to distribute incentive dollars once they are in the network. The
distribution methodology should 1) distribute funds based on measurable
performance, 2) be transparent, 3) reward physicians for their individual
contribution and performance and 4) maintain a level of simplicity, according
to Mr. Butts. He says leaders of the network often build individual and network
incentive pools into the distribution methodology to achieve these objectives.
Source: beckershospitalreview
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